All About Coronavirus Symptoms in Children and Infants
Infants and children usually display mild symptoms of COVID-19, but severe complications are also possible—especially for those with underlying conditions. Here's what parents need to know.
The novel coronavirus, SARS-CoV-2, (and the disease it causes, COVID-19) has the entire world on edge, but perhaps nobody is as concerned as parents. It can seem impossible to shield children from illnesses when germs are unpredictable and omnipresent. And while experts initially reported that COVID-19 mostly spares children and infants, recent research suggests they aren't entirely off the hook. In fact, in July 85 infants tested positive for the coronavirus in one Texas county. And a new study out of South Korea found that children between the ages of 10 and 19 were just as likely to spread COVID-19 as adults.
Half a million American children have been diagnosed with COVID-19, according to the American Academy of Pediatrics (AAP) and the Children's Hospital Association, with over 70,000 new cases—a 16 percent increase—between August 20 and September 3. And a September CDC report found that while only 0.03 percent of cases in children and young people under 21 have been fatal, Black and Hispanic populations are at the most risk.
"These numbers are a chilling reminder of why we need to take this virus seriously," AAP president Sally Goza, M.D., said in a news release. "While much remains unknown about COVID-19, we do know that the spread among children reflects what is happening in the broader communities."
Here's what parents need to know about the coronavirus and children, plus tips for preventing the respiratory illness.
What are Coronavirus Symptoms in Children?
It's true that COVID-19 doesn't appear to affect children as severely. Indeed, a study from the London School of Hygiene & Tropical Medicine, published in June 2020 in Nature Medicine, found that people under 20 years old are half as likely to become infected with the coronavirus. What's more, only 21 percent of patients between 10 to 19 years old displayed symptoms. In comparison, 69 percent of people over 70 experienced COVID-19 symptoms.
According to the Centers for Disease Control and Prevention (CDC), available research suggests that symptomatic children usually present with fever, runny nose, cough, or gastrointestinal issues such as vomiting and diarrhea. It's important to note, though, that COVID-19 doesn't look the same for everyone. Some children experience no symptoms whatsoever, while others have severe cases that lead to respiratory distress or death (but this is rare).
Experts also discovered that, despite the fact that children have milder COVID-19 cases, they still carry high concentrations of the virus. A July 2020 study published in JAMA Pediatrics found that children under five years old have anywhere from 10 to 100 times the amount of virus in their noses and throat (although the report didn't indicate that children were more contagious than adults). This fact is especially concerning as experts weigh the risks of reopening schools this fall.
The risk of serious illness seems to increase if the child has an underlying medical condition. Indeed, a study published on May 11 in JAMA Pediatrics focused on the "early experience of COVID-19 in pediatric intensive care units (PICUs)" by collecting research from 46 PICUs in North America. It found that 48 American children were admitted to 14 PICUs between March 14 and April 3. A majority (83 percent) had underlying medical conditions, 38 percent needed ventilators, and 4.2 percent died.
Rarely, the coronavirus can lead to a condition dubbed pediatric multisystem inflammatory syndrome. Several children have died from the mysterious illness, which resembles Kawasaki disease and appears to be linked to COVID-19. Symptoms include fever, rash, abdominal pain, vomiting, and diarrhea, according to Demetre C. Daskalakis, M.D., MPH, deputy commissioner of the New York City Health Department's Division of Disease Control, in a letter to colleagues. And while more information is needed, experts think it may be an immune system overreaction to COVID-19 exposure.
Teenagers aren't off the hook either. In fact, experts are currently seeing more COVID-19 cases in older teens. There are a few reasons behind this trend: Teens aren't practicing social distancing as strictly, they might not believe the coronavirus will affect them, and they're more likely to vape. Vaping and cigarette smoking has been associated with an increased risk of the coronavirus, since these actions compromise the respiratory system, according to the Cleveland Clinic.
How Are Babies and Infants Being Affected?
According a World Health Organization (WHO) - China Joint Mission report on the coronavirus, published in mid-February 2020, kids of all ages are susceptible to COVID-19, but young children might be more vulnerable. The report concluded that the proportion of severe and critical cases was 10.6 percent for infants under 1 and 7.3 percent for kids ages 1 to 5, compared to 3 percent for 15- to 18-year-olds. And now there's mounting evidence that babies can become infected with COVID-19 across the placenta in the womb.
Like older children, however, babies display mild symptoms in most cases, and they might also be asymptomatic. Limited research published by the CDC says COVID-19 symptoms in babies may include fever, rhinorrhea (runny nose), vomiting, cough, tachypnea (rapid breathing), vomiting, diarrhea, and decreased feeding. And while most infants recovered without any issues, severe complications and death have also been reported.
Asymptomatic presentation is a relief for parents, but it leads to another issue: Babies might unknowingly spread the coronavirus to their caregivers. Take this case in Singapore published in the journal Clinical Infectious Diseases, which involves a 6-month-old baby. After a mother and nanny were hospitalized with pneumonia—and the father came down with a fever and sore throat—hospital staff found the baby had high levels of the coronavirus in his "throat, blood, and stool," according to the Los Angeles Times. The baby was asymptomatic, which caused the coronavirus to spread easily to caregivers. He didn't develop any symptoms during a subsequent hospital stay (with the exception of a very short-lived fever).
These "silent cases" could help spread the coronavirus even further, which is particularly worrisome for grandparents and caregivers with compromised immune systems.
Why is the Coronavirus Generally Mild for Children?
Since the coronavirus is a novel disease, experts still don’t know many things about it—including why children usually have lower transmission rates and milder symptoms. “We don’t definitively know the reason,” says K.C. Rondello, M.D., MPH, CEM, clinical associate professor at the College of Nursing and Public Health at Adelphi University. “Everyone from virologists to epidemiologists to infectious disease doctors are completely stymied as to why we’re seeing this phenomenon.”
Here are a few theories, however, within the medical community:
Kids Have a Better Immune Response
One theory is that children have better immune responses than adults, which helps them fight off the coronavirus. “Children’s immune systems are not fully functional until later in their development. As a result, they have a considerably stronger and more robust immune response to pathogens than adults,” explains Dr. Rondello.
What’s more, “The death rate for COVID-19 is higher among individuals with certain pre-existing conditions, such as cardiovascular disease, diabetes, and cancer. This may help explain why many children seem to be at lower risk, since they are less likely to have these types of preexisting conditions,” says Aimee Ferraro, Ph.D., faculty member for Walden University’s Master of Public Health (MPH) program.
Many experts tentatively support the hypothesis, but there’s also a hitch: The coronavirus seems to spare most infants even though their immune systems aren’t fully formed yet.
Experts Might Not Be Identifying All Coronavirus Cases
Robert Frenck, M.D., medical director of the Division of Infectious Diseases at Cincinnati Children’s Hospital, says that a reporting bias might be to blame. When the coronavirus first emerged, doctors in America and China were only testing people with severe symptoms. But they’ve since found that milder, cold-like symptoms may also occur.
“It’s possible that the coronavirus causes a spectrum of illnesses, and that medical organizations are only identifying the more serious ones,” summarizes Dr. Frenck. Children might not be getting diagnosed if they’re only experiencing mild symptoms—which means the coronavirus may be affecting more children (and people in general) than reported.
Kids Could Have "Immunological Cross-Protection"
According to Dr. Rondello, a number of different viruses could give you the common cold—including milder forms of coronavirus. “Children get colds a lot, so they’re already being exposed to more benign, less intense coronaviruses. They could have potentially built immunity to them,” he says. Dr. Rondello calls this “immunological cross-protection.”
Smoking is a Potential Risk Factor
An earlier theory suggested that smoking might be a risk factor for COVID-19, since smokers tend to have greater SARS-COV receptors. “And since children do not smoke, they would be less susceptible to lower respiratory tract infections like COVID-19,” says Dr. Ferraro. This hypothesis has fallen out of favor, though, since experts found that the coronavirus transmission was comparable in counties with both high levels and low levels of smoking.
How to Prevent Coronavirus in Children
Like the cold and flu, the coronavirus is a respiratory illness that spreads through contaminated droplets. These droplets enter the body through the eyes, nose, and mouth, says Miryam Wahrman, PhD, biology professor and director of the microbiology research lab at William Paterson University in Wayne, New Jersey, and author of The Hand Book: Surviving in a Germ-Filled World. Airborne transmission may also be possible.
The absolute best coronavirus prevention method, says Dr. Wahrman, is washing your hands with soap and water for at least 20 seconds. Alcohol-based hand sanitizer can also work in a pinch. Washing your hands is especially important before eating or touching your face. Parents should also disinfect common surfaces like doorknobs and countertops often.